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Biomedical subjects

L B Reller

Publications and source records attributed to L B Reller.

At least 19 recordsLinked to original sources
PubMed1992

Ofloxacin, a new broad-spectrum fluoroquinolone. Results from a Multicenter, National Comparative Activity Surveillance Study. The Ofloxacin Surveillance Group.

Ofloxacin, a newer broad-spectrum fluoroquinolone, was evaluated against 6967 clinical isolates in a multicenter surveillance trial using a standardized disk diffusion method. Thirty-five geographically diverse laboratories contributed zone diameter results for two (ofloxacin and ciprofloxacin) to five (ofloxacin, ciprofloxacin, ampicillin, cefaclor, and cefixime) antimicrobial agents, depending on the site of infection. Ofloxacin was determined to have the widest spectrum of activity and potential empiric use (90.6%, range 87.1%-92.2%) for respiratory tract, urinary tract, and cutaneous infections. The spectrum was superior to ciprofloxacin (average 85.3% versus three sites), ampicillin (35.5%, respiratory tract), cefaclor (60.5%, respiratory tract), cefixime (60.9%, respiratory tract), and norfloxacin (87.3%, urinary tract). Strains resistant to ofloxacin (35 isolates, 0.5%) were confirmed by reference laboratory tests and cross resistance was observed among several current and investigational fluoroquinolone agents. The species most often found to be fluoroquinolone resistant among the Enterobacteriaceae were Klebsiella pneumoniae, Serratia marcescens, and Providencia spp. Monitoring for increasing fluoroquinolone resistance should be considered as greater use of drugs in this class develops. By these cited statistics, ofloxacin appears to have a broad and balanced spectrum of potential use, particularly against Gram-positive pathogens.

Anti-Infective Agents↗
PubMed1992

General guidelines for clinical bacteriology. Infectious Diseases Society of America and the Food and Drug Administration.

This guideline summarizes recommendations for (1) developing cogent procedures for diagnosis and antimicrobial susceptibility testing; (2) developing quality-control parameters for the microbiological components of clinical trials; (3) continually updating U.S. Food and Drug Administration (FDA) guidelines; (4) reviewing microbiological recommendations from other groups, such as Microbiology Subcommittees of the National Committee for Clinical Laboratory Standards; and (5) improving the microbiological aspects of FDA package inserts for antimicrobial drugs. Sensitive and specific methods for isolation and identification of pathogens are essential to the proper conduct of clinical trials. Susceptibility tests should be performed in an accurate and reproducible fashion. Verification of results in a reference laboratory is encouraged to monitor quality control.

Anti-Bacterial Agents↗
PubMed1992

Controlled evaluation of BACTEC PLUS 27 and Roche Septi-Chek anaerobic blood culture bottles.

Becton Dickinson Diagnostic Instrument Systems (Sparks, Md.) recently introduced BACTEC high-volume aerobic and anaerobic bottles that accept up to 10 ml of blood for use on their nonradiometric blood culture instruments. Both bottles contain 25 ml of tryptic soy broth, 0.05% sodium polyanetholesulfonate, and mixed resins. We compared the anaerobic bottle, designated BACTEC PLUS 27 (BP27), with the Roche Septi-Chek (RSC) Columbia broth anaerobic bottle in a collaborative evaluation at three university hospitals. A total of 5,152 adequately filled blood cultures were obtained from adult patients with suspected bacteremia or fungemia. Staphylococcus aureus was recovered significantly more often (P less than 0.03) from BP27 bottles alone; there were no other significant differences in yield. When microorganisms were recovered from both anaerobic bottles, growth was detected earlier in BP27 than it was in RSC (P less than 0.001), especially for S. aureus (P less than 0.001) and Staphylococcus epidermidis (P less than 0.02). We conclude that the yield from BP27 bottles is equivalent to or better (S. aureus) than that from RSC anaerobic bottles with Columbia broth and that speed of detection is superior with BP27 bottles.

Adult↗
PubMed1992

Application of rejection criteria for stool ovum and parasite examinations.

We retrospectively determined the yield of 2,015 stool ovum and parasite (O&P) examinations performed over an 11-month period. Two aspects were evaluated: the yield of positive results from multiple specimens per patient versus the result of a single examination, and the yield of positive results from stools submitted after 3 days of hospitalization. There were 131 (6.7%) positive O&P examinations from 75 patients: for 35 patients the single examination was positive; for 18, two of two examinations were positive; and for 15, three of three examinations were positive. The remaining seven patients had at least one negative examination in a series, but pathogenic intestinal parasites were detected in only three of these patients. Seventeen patients with positive O&P examinations were inpatients: seven of nine patients examined for O&P within 3 days of admission had stool specimens that contained recognized pathogens, in contrast to only two of eight patients examined after 3 days of hospitalization. After reviewing the data and informing hospital clinics, wards, and physicians, we instituted the following policy for screening stool specimens submitted for O&P examination. Only one O&P examination was performed for each outpatient visit and for inpatients hospitalized for 3 days or less, and examinations were not performed on stools submitted after 3 days of hospitalization unless the clinician arranged for the examination on the basis of clinical need. Over the 6-month follow-up period, 29.9% of O&P requests were rejected, 22% for patients in hospital for longer than 3 days and 7.9% for multiple O&P requests. Of 265 initially rejected specimens, 22 (8.3%) were examined after the referring physician contacted the laboratory. None of these specimens was positive. We conclude that eliminating O&P examinations of patients hospitalized for more than 3 days and initially performing only one examination per patient significantly reduces the number of examinations performed and reduces laboratory charges without adversely affecting patient care.

Adult↗
PubMed1992

Controlled comparison of the BacT/Alert and BACTEC 660/730 nonradiometric blood culture systems.

In a collaborative study at three university hospitals, the recovery of microorganisms and the speed of detection of microbial growth by the BacT/Alert (Organon Teknika Corporation, Durham, N.C.) and BACTEC 660/730 (Becton-Dickinson Diagnostic Instrument Systems, Sparks, Md.) nonradiometric blood culture systems were compared. A total of 5,918 comparisons were made between BacT/Alert aerobic and BACTEC NR 6A bottles and 5,992 comparisons were made between BacT/Alert anaerobic and BACTEC NR 7A bottles. Each bottle was inoculated with 5 ml of blood. The overall recoveries of microorganisms from the two aerobic bottles were comparable; members of the family Enterobacteriaceae were recovered more often from BacT/Alert aerobic bottles alone (P less than 0.001). The overall recoveries of microorganisms from the anaerobic bottles were not significantly different. Growth of Staphylococcus aureus (P less than 0.001), coagulase-negative staphylococci (P less than 0.01), streptococci (P less than 0.001), Escherichia coli (P less than 0.01), other members of the family Enterobacteriaceae (P less than 0.02), and Pseudomonas aeruginosa (P less than 0.05) was detected earlier in BacT/Alert aerobic bottles. Growth of S. aureus (P less than 0.001), coagulase-negative staphylococci (P less than 0.05), enterococci (P less than 0.01), Streptococcus pneumoniae (P less than 0.02), viridans group streptococci (P less than 0.05), E. coli (P less than 0.001), Klebsiella pneumoniae (P less than 0.01), and other members of the family Enterobacteriaceae (P less than 0.001) was detected earlier in BacT/Alert anaerobic bottles. In a system-versus-system comparison, more gram-positive cocci were recovered from the BACTEC system alone (P < 0.05), and more members or the family Enterobacteriaceae were recovered from the BacT/Alert system alone (P < 0.001). As a system, the BacT/Alert system detected growth of S. aureus (P < 0.001), coagulase-negative staphylococci (P < 0.01), streptococci (P < 0.001), E. coli (P < 0.001), other members of the familyEnterobacteriaceae (P < 0.001), and P. aeruginosa (P < 0.05) earlier than the BACTEC system did. Significantly fewer (40 versus 1,183) false-positive results occurred with the BacT/Alert system. We conclude that the BacT/Alert and BACTEC 660/730 nonradiometric systems are comparable for recovering clinically significant microorganisms form adult patients with bacteremia or fungemia, but that the BacT/Alert system detects microbial growth earlier than the BACTEC system does, with significantly fewer false-positive results.

Adult↗
PubMed1992

Revision of standards for adjusting the cation content of Mueller-Hinton broth for testing susceptibility of Pseudomonas aeruginosa to aminoglycosides.

A multilaboratory study was undertaken to reassess the amount of calcium and magnesium that should be added to Mueller-Hinton broth when testing Pseudomonas aeruginosa against amikacin, gentamicin, isepamicin, netilmicin, and tobramycin. To achieve parity with agar dilution tests, cation-adjusted broth should contain 20 to 25 mg of calcium and 10 to 12.5 mg of magnesium per liter rather than the 50- and 25-mg/liter supplements recommended previously. For quality control of tests with contemporary media, MIC control limits should be adjusted by lowering the current MIC limits by at least 1 doubling-dilution interval.

Aminoglycosides↗
PubMed1991

Issues in cerebrospinal fluid management. CSF Venereal Disease Research Laboratory testing.

Three policies for decreasing unnecessary cerebrospinal fluid (CSF) management Venereal Disease Research Laboratory (VDRL) tests were compared. The first policy attempted to educate physicians about the use of serologic tests for diagnosing neurosyphilis but allowed the CSF VDRL to be performed either as a screening test or as a retrospective test. The second policy required that the CSF VDRL be performed as a retrospective test without regard to the patient's serologic status. The third policy required that a patient be seropositive by either rapid plasma reagin (RPR) or fluorescent treponemal antibody absorbance (FTA-ABS) before a CSF VDRL could be performed. Before these policies were instituted, VDRL testing was performed on 18.2% of all CSF samples. The optional and required retrospective policies decreased the CSF VDRL rate to 13.0% and 8.5%, respectively, but the percentages of seropositive patients for whom these procedures were performed were only 7.3% and 12.9%. The third policy decreased the CSF VDRL test rate to 1.8% (P less than 0.001) with seropositivity improving to 90%. To assure serologic tests are obtained in the evaluation of neurosyphilis, requirement for seropositivity must be implemented with the use of retrospective CSF VDRL testing.

Antibodies, Bacterial↗
PubMed1991

Issues in cerebrospinal fluid management. Acid-fast bacillus smear and culture.

Meningeal tuberculosis is an uncommon disease in the United States with an annual incidence of fewer than 200 cases. This study evaluates three approaches to improving the use of the cerebrospinal (CSF) acid-fast bacillus (AFB) smear and culture procedure: (1) education alone; (2) optional screening by which physicians can select to have the AFB analysis stopped if the initial CSF findings are unremarkable; and (3) mandatory screening before the performance of all CSF AFB analyses. With education alone, the CSF AFB culture rate decreased from 20.6% of all CSF acquisitions to 15.7% (P less than 0.001); however, the effect may have been related to a decrease in all types of AFB testing. Optional screening had no impact on the AFB testing rate. Mandatory screening significantly decreased the CSF AFB rate to 6.7% (P less than 0.001), unrelated to changes in other types of AFB testing. Laboratories that employ mandatory screening should report the screening results immediately and have a mechanism whereby physicians can bypass the screen, providing CSF AFB analysis on unremarkable fluid from high-risk patients.

Adolescent↗
PubMed1991

Controlled evaluation of BACTEC Plus 26 and Roche Septi-Chek aerobic blood culture bottles.

Blood culture bottles that accept up to 10 ml of blood have recently been introduced for the BACTEC nonradiometric blood culture system. The new formulation, designated BACTEC Plus, contains 25 ml of tryptic soy broth, 0.05% sodium polyanetholesulfonate, and mixed resins. In a collaborative study conducted at three university hospitals, we evaluated the BACTEC Plus 26 (BP26) aerobic bottle and the Roche Septi-Chek aerobic bottle with its agar slide paddle in 5,293 paired blood cultures. Significantly more microorganisms (P less than 0.001), especially Staphylococcus aureus (P less than 0.001), Staphylococcus epidermidis (P less than 0.01), enterococci (P less than 0.005), and members of the family Enterobacteriaceae (P less than 0.005), were detected by the BP26 bottle. When both bottles detected growth, BP26 did so earlier (P less than 0.001). In particular, S. epidermidis (P less than 0.001), streptococci (P less than 0.005), enterococci (P less than 0.05), and members of the family Enterobacteriaceae (P less than 0.001) were detected earlier by the BP26 bottle. We conclude that the BP26 bottle provides a yield and speed of detection of microorganisms superior to those of the Roche Septi-Chek aerobic blood culture bottle.

Adult↗
PubMed1990

Pyrazinamide and pyrazinoic acid activity against tubercle bacilli in cultured human macrophages and in the BACTEC system.

Pyrazinamide (PZA) has become an essential component of current 6-month regimens for therapy of tuberculosis. Susceptible strains of tubercle bacilli convert PZA to pyrazinoic acid (POA) through pyrazinamidase (PZase), which resistant strains and Mycobacterium bovis bacille Calmette-Guérin lack. PZA susceptibility results obtained in cultured human macrophages were compared with those in the broth BACTEC system with 7H12 medium at pH 6.0 for strains known to be PZase-positive or -negative. Although added POA was unable to inhibit tubercle bacilli in cultured macrophages, it was able to inhibit them at very high concentrations in the BACTEC broth. Intracellularly formed POA would not be able to escape from the macrophage, and therefore would accumulate sufficiently to lower pH to toxic levels for tubercle bacilli. The results suggest that the cultured macrophages contribute actively or passively to the effectiveness of PZA, such as through the proposed mechanism of low pH generated by PZase in the phagolysosomes.

Amidohydrolases↗
PubMed1990

Effect of altered headspace atmosphere on yield and speed of detection of the Oxoid Signal blood culture system versus the BACTEC radiometric system.

The one-bottle Oxoid Signal blood culture system altered to provide a more aerobic bottle headspace was reassessed in a comparative study versus the two-bottle BACTEC radiometric system in 5,426 blood cultures. The BACTEC system detected more microorganisms (P less than 0.02), particularly anaerobes (P less than 0.05) and fungi (P less than 0.05).

Bacteria↗
PubMed1990

BacT/Alert: an automated colorimetric microbial detection system.

BacT/Alert (Organon Teknika Corp., Durham, N.C.) is an automated microbial detection system based on the colorimetric detection of CO2 produced by growing microorganisms. Results of an evaluation of the media, sensor, detection system, and detection algorithm indicate that the system reliably grows and detects a wide variety of bacteria and fungi. Results of a limited pilot clinical trial with a prototype research instrument indicate that the system is comparable to the radiometric BACTEC 460 system in its ability to grow and detect microorganisms in blood. On the basis of these initial findings, large-scale clinical trials comparing BacT/Alert with other commercial microbial detection systems appear warranted.

Bacteria↗
PubMed1989

Clinical and immunologic significance of cholera-like toxin and cytotoxin production by Campylobacter species in patients with acute inflammatory diarrhea in the USA.

The humoral immune response to both Campylobacter jejuni cell surface antigens and to potential toxins of the organism was studied in 64 adults with inflammatory diarrhea. In an enzyme-linked immunosorbent assay (ELISA) for surface antigens, 17 (71%) of 24 persons with Campylobacter enteritis showed seroconversion in more than one immunoglobulin class, versus only 2 (5%) of 40 patients with non-Campylobacter enteritis. In a GM1, ganglioside-based ELISA for detecting serum IgG to cholera-like enterotoxin, only one patient studied showed seroconversion to the enterotoxin. Of 22 Campylobacter isolates studied for production of cholera-like toxin, none of the supernatants from the Campylobacter strains were positive. Supernatants were also tested for enterotoxin and cytotoxic activity on Chinese hamster ovary cells; all isolates were negative for enterotoxin activity. In contrast, cytotoxin was produced by 7 (32%) isolates but was usually low-level and was not neutralized by patient's serum. These findings indicate that production of cholera-like toxin and cytotoxin by Campylobacter strains in the United States occurs in few strains and that host immune response is absent; their biologic significance in the pathogenesis of Campylobacter infections remains unclear.

Acute Disease↗
PubMed1989

Comparative evaluation of radiometric tryptic soy broth versus radiometric tryptic soy broth with 10% sucrose for detection of bacteremia and fungemia in pediatric patients.

We compared BACTEC radiometric blood culture media with (8B) and without (6B) 10% sucrose for the detection of bacteremia and fungemia in pediatric patients at four university teaching hospitals that used identical methods for obtaining and processing specimens. Overall, the yields of microorganisms from 5,714 blood culture sets were no different in the two media, although a trend was noted favoring 6B for the detection of pneumococci. Speed of detection of positive results was faster in the 6B than in the 8B medium (P less than 0.05), largely due to the faster detection of Staphylococcus aureus in the 6B medium. We conclude that, overall, with pediatric patients the hypertonic 8B radiometric medium has no advantage and that it possibly has a modest disadvantage, compared with isotonic 6B radiometric medium.

Bacteria↗
PubMed1989

Controlled comparison of a new Becton Dickinson agar slant blood culture system with Roche Septi-Chek for the detection of bacteremia and fungemia.

Two commercially available agar slide blood culture systems, Septi-Chek (Roche Diagnostics, Div. Hoffmann-La Roche Inc., Nutley, N.J.) and VACUTAINER agar slant (Becton Dickinson [BD] Vacutainer Systems, Rutherford, N.J.), were compared in 5,628 paired blood cultures from adult patients. The systems were inoculated with equal volumes (5 ml) of blood. There was no statistically significant difference between the two systems in the overall recovery of clinically important microorganisms; however, significantly more Escherichia coli (P less than 0.05) organisms were detected in the Septi-Chek system. Concurrently, significantly more contaminants (P less than 0.001) also were present in Septi-Chek bottles. When microorganisms grew in both systems, there was no significant difference in the time to recovery of important organisms, except that anaerobes were detected more quickly in the BD system. This study suggests that the BD VACUTAINER agar slant is an acceptable alternative to the Septi-Chek system for routine blood cultures.

Bacteria↗
PubMed1989

Effect of agitation and terminal subcultures on yield and speed of detection of the Oxoid Signal blood culture system versus the BACTEC radiometric system.

In an initial evaluation, we found the Oxoid Signal blood culture system inferior to the BACTEC radiometric system for detection of some microorganisms causing septicemia (M. P. Weinstein, S. Mirrett, and L. B. Reller, J. Clin. Microbiol. 26:962-964, 1988). To determine whether modified processing of the Oxoid Signal blood culture system could improve its yield and speed of detecting positive cultures relative to the BACTEC radiometric system, we agitated all Oxoid bottles during the first 24 to 48 h of incubation and performed aerobic and anaerobic subcultures of all Oxoid bottles negative after 7 days of incubation. These modifications improved the overall performance of the Oxoid system, particularly with regard to the yield of streptococci, members of the family Enterobacteriaceae, and Haemophilus, Neisseria, and Acinetobacter spp. The speed of detecting positive cultures also was improved, especially within the first 24 h of incubation. However, the BACTEC system still detected more positive cultures (P less than 0.005), especially of obligate aerobes such as Pseudomonas aeruginosa (P less than 0.05) and yeasts (P less than 0.005). The BACTEC system also detected positive cultures earlier than the Oxoid system (e.g., at 24 h of incubation, 70.5% of BACTEC positive cultures detected versus 62.1% of Oxoid positive cultures detected). Further modifications of the Oxoid system which might include a revised medium, additional processing modifications, altered headspace atmosphere, or a complementary second broth medium should be considered, since the system is attractive in concept and is easy to use in the clinical laboratory.

Aerobiosis↗
PubMed1989

Diagnosis of Giardia lamblia infections by detection of parasite-specific antigens.

Antigen detection methods may facilitate diagnosis of Giardia lamblia in stool specimens. As determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis and immunoblotting, G. lamblia cysts and trophozoites share several antigens, especially in the 65-kilodalton and 30- to 34-kilodalton regions. By using blind methods, we compared results obtained by counterimmunoelectrophoresis using cyst-immune rabbit serum and by enzyme-linked immunosorbent assay (ELISA) using trophozoite-immune rabbit serum with results obtained by microscopic examination of a preserved, concentrated, and permanently stained stool specimen. Results were similar when these three methods were used to examine 118 stool specimens from clinical microbiology laboratories (53 specimens with G. lamblia) and specimens from 239 day-care-center toddlers (39 specimens with G. lamblia). Compared with microscopy, we found, for counterimmunoelectrophoresis and ELISA, respectively: sensitivity, 88 versus 94%; specificity, 97 versus 95%; positive predictive value, 86 versus 76%; negative predictive value, 98 versus 97%; and concordance, 89%. The false-positive rate by ELISA was 24% (10 of 42) in day-care-center toddlers but only 3% (1 of 32) in healthy adults (P less than 0.04) as corroborated by microscopy. This discrepancy suggests that the ELISA may be more sensitive than microscopy, which is considered the reference standard, and that results may be dependent, in part, on the epidemiology of the infection in the study subjects.

Animals↗